Medical Surgical Nursing

1. Assess patient's and family's

responses and reactions to illness

and treatment.

2. Assess relationship of patient

and significant family members.

3. Assess usual coping patterns of

patient and family members.

4. Encourage open discussion of

concerns about changes

produced by disease and

treatment:

a. Role changes

b. Changes in lifestyle

c. Changes in occupation

d. Sexual changes

e. Dependence on health

care team

5. Explore alternate ways of sexual

expression other than sexual

intercourse.

6. Discuss role of giving and

receiving love, warmth, and

affection.

1. Provides data about

problems encountered

by patient and family in

coping with changes in

life.

2. Identifies strengths and

supports of patient and

family.

3. Coping patterns that

may have been effective

in past may be harmful

in view of restrictions

imposed by disease and

treatment.

4. Encourages patient to

identify concerns and

steps necessary to deal

with them.

5. Alternative forms of

sexual expression may

be acceptable.

6. Sexuality means

different things to

different people,

depending on stage of

maturity.

 Identifies

previously used

coping styles that

have been effective

and those no longer

possible due to

disease and

treatment (alcohol

or drug use;

extreme physical

exertion)

 Patient and family

identify and

verbalize feelings

and reactions to

disease and

necessary changes

in their lives

 Seeks professional

counseling, if

necessary, to cope

with changes

resulting from

renal failure

 Reports satisfaction

with method of

sexual expression

Collaborative Problems: Hyperkalemia; pericarditis, pericardial effusion, and pericardial tamponade;
hypertension; anemia; bone disease and metastatic calcifications
Goal: Absence of complications
Hyperkalemia

1. Monitor serum potassium levels.
   Notify physician if level greater
   than 5.5 mEq/L, and prepare to
   treat hyperkalemia.


2. Assess patient for muscle
   weakness, diarrhea, ECG
   changes (tall-tented T waves and
   widened QRS).

1. Hyperkalemia causes

potentially life-

threatening changes in

the body.

2. Cardiovascular signs

and symptoms are

characteristic of

hyperkalemia.

 Patient has normal

potassium level

 Experiences no muscle

weakness or diarrhea.

 Exhibits normal ECG

pattern

 Vital signs are within

normal limits

Pericarditis, Pericardial Effusion, and Pericardial Tamponade

1. Assess patient for fever, chest
   pain, and a pericardial friction
   rub (signs of pericarditis) and, if
   present, notify physician.


2. If patient has pericarditis, assess
   for the following every 4 hours:
   a. Paradoxical pulse > 10
   mm Hg
   b. Extreme hypotension

1. About 30%–50% of

chronic renal failure

patients develop

pericarditis due to

uremia; fever, chest

pain, and a pericardial

friction rub are classic

signs.

2. Pericardial effusion is a

 Has strong and

equal peripheral

pulses

 Absence of a

paradoxical pulse

 Absence of

pericardial effusion

or tamponade on

cardiac ultrasound